NEET-PG 2020 Practice Questions

Q: Stimulation of the external auditory canal leads to cough due to which nerve?

Auricular branch of vagus. ***Auricular branch Vagus*** - The **auricular branch of the vagus nerve (Arnold's nerve)** innervates the posterior and inferior walls of the external auditory canal. - Stimulation of this nerve can trigger the **cough reflex**, as the vagus nerve is also responsible for innervating the larynx, pharynx, and trachea. *Greater auricular nerve* - The **greater auricular nerve** is a cutaneous nerve from the cervical plexus (C2-C3) that supplies sensation to the skin over the mastoid process, posterior auricle, and part of the earlobe. - It does not directly innervate the external auditory canal in a way that would trigger a cough reflex. *Auriculotemporal nerve* - The **auriculotemporal nerve** is a branch of the mandibular nerve (V3) that provides sensory innervation to the temporomandibular joint, skin over the temple, and part of the external ear. - While it innervates part of the ear, its stimulation does not typically elicit a cough reflex. *Facial Nerve* - The **facial nerve** is primarily responsible for motor innervation of the muscles of facial expression and taste sensation to the anterior two-thirds of the tongue. - Although it has a small sensory component to the external ear (via auricular branches), it is not the primary nerve responsible for the cough reflex when the external auditory canal is stimulated.

Q: Which of the following is the law on child sexual abuse in India?

Protection Of Children from Sexual Offences Act (POCSO). ***Protection Of Children from Sexual Offences Act (POCSO)*** - The **POCSO Act** was specifically enacted in India to address and prevent child sexual abuse, providing a comprehensive legal framework for protection, prosecution, and rehabilitation. - It defines various forms of sexual offenses against children and ensures a child-friendly process for reporting and trial. *Juvenile Justice (Care and Protection of Children) Act* - This act primarily deals with the **care, protection, rehabilitation, and social reintegration of children** in conflict with law and children in need of care and protection. - While it ensures the overall well-being of children, it is not specifically focused on defining and prosecuting child sexual abuse. *Indian Penal Code (IPC) Section 375* - **IPC Section 375 defines rape** in India, but it primarily addresses sexual assault against women and does not specifically cater to children as a vulnerable group with distinct legal protections against sexual exploitation. - The POCSO Act was introduced to provide more stringent and child-specific provisions beyond the general framework of the IPC. *Prohibition of Child Marriage Act* - This act aims to **prohibit child marriages** and makes it an offense to solemnize or facilitate such marriages. - While child marriage can sometimes involve sexual exploitation, this act is not the primary legislation for addressing child sexual abuse in general.

Q: Identify the condition given in the image below?

Chronic lymphedema. ***Chronic lymphedema*** - The image shows a **swollen foot** with **thickened, dry, and hyperkeratotic skin**, and **deep skin folds**, particularly between the toes. This is characteristic of **chronic lymphedema** due to impaired lymphatic drainage. - The presence of the **Stemmer's sign** (inability to pinch and lift the skin at the base of the second toe) is a common finding in lymphedema, which can be inferred from the overall appearance of the toes. *Cushing syndrome* - Cushing syndrome is characterized by **central obesity**, **moon facies**, **buffalo hump**, and **thin, fragile skin** with **striae**, not typically severe localized edema and skin changes as seen in the image. - While fluid retention can occur, it does not manifest as the characteristic cutaneous changes of chronic lymphedema. *Osteoporosis* - Osteoporosis is a condition of **decreased bone density**, making bones fragile and prone to fractures. - It does not present with visible skin changes or edema as depicted in the image. *None of the options* - The image clearly shows severe manifestations identifiable as **chronic lymphedema**, therefore one of the provided options is correct.

Q: Identify the parasite shown in the image.

Trichuris trichiura. ***Trichuris trichiura*** - The image displays characteristic **lemon-shaped** or **barrel-shaped eggs** with distinctive **polar plugs** at each end, which are pathognomonic for *Trichuris trichiura* (whipworm) eggs. - These eggs are thick-shelled and typically measure 50-55 µm by 20-25 µm, containing an undeveloped larva when passed in feces. *Ancylostoma duodenale* - Eggs of *Ancylostoma duodenale* (Old World hookworm) are **oval-shaped** with blunt ends, and a **thin shell**. - They typically contain a **segmented ovum** or an early-stage larva, lacking the polar plugs seen in the image. *Paragonimus westermani* - *Paragonimus westermani* (lung fluke) eggs are generally **oval-shaped** with a **flattened operculum** at one end, which is not visible in the image. - They are larger than *Trichuris* eggs, often measuring around 80-120 µm by 45-70 µm, and are often coughed up in sputum or passed in feces. *Strongyloides stercoralis* - *Strongyloides stercoralis* primarily produces **larvae** (rhabditiform or filariform) in stool samples rather than eggs. - If eggs are seen (rarely, in cases of severe diarrhea), they are small, thin-shelled, and typically contain a developed larva, unlike the eggs shown.

Q: Which of the following cell components produced by Neisseria gonorrhoeae is responsible for attachment to host cells?

Pili (fimbriae). ***Pili (fimbriae)*** - **Pili** are hair-like appendages on the surface of *Neisseria gonorrhoeae* that facilitate initial attachment to **eukaryotic host cells**, particularly epithelial cells in the genitourinary tract. - This attachment is crucial for **colonization** and preventing the bacteria from being washed away by bodily fluids. *Lipooligosaccharide* - **Lipooligosaccharide (LOS)** is a major component of the outer membrane of *Neisseria gonorrhoeae* that contributes to **virulence** through its endotoxin activity, causing inflammation and tissue damage. - While it's important for pathogenicity, its primary role isn't direct attachment but rather the **immune response modulation** and tissue invasion. *IgA1 protease* - **IgA1 protease** is an enzyme produced by *Neisseria gonorrhoeae* that cleaves **IgA1 antibodies**, which are found on mucosal surfaces. - This enzyme helps the bacteria **evade the host immune response** by destroying protective antibodies, not directly mediating cell attachment. *Outer membrane porin protein* - **Outer membrane porin proteins (Porins)** form channels in the outer membrane of *Neisseria gonorrhoeae*, allowing the passage of small molecules. - While important for bacterial metabolism and survival, porins are not the primary structures responsible for **initial host cell attachment**.

Q: A 7 weeks pregnant lady has 1 accidental exposure to x-ray. Which of the following should be done?

Continue the pregnancy with monitoring. ***Continue the pregnancy with monitoring*** - The risk of **fetal malformation** and **intellectual disability** from a single diagnostic X-ray exposure is generally considered very low, often below the threshold for clinical concern. - Current guidelines typically recommend continuing pregnancy with routine monitoring unless the estimated fetal dose exceeds a certain threshold (e.g., 50-100 mGy), which is unlikely with a single accidental exposure. *Perform chromosome analysis if needed* - **Chromosome analysis** is generally reserved for cases with suspected genetic anomalies or significant fetal exposure to radiation at doses known to induce chromosomal damage. - A single, accidental X-ray exposure is unlikely to cause clinically significant chromosomal aberrations requiring such invasive testing. *Conduct pre-invasive diagnostic testing if indicated* - **Pre-invasive diagnostic testing**, such as nuchal translucency scans or maternal serum screening, assesses risks for common aneuploidies and neural tube defects, not typically direct radiation effects. - While these tests are part of routine prenatal care, a single X-ray exposure does not, by itself, create a specific indication for additional pre-invasive testing beyond standard recommendations. *Consider termination of pregnancy* - **Termination of pregnancy** is usually considered only in cases of significant, confirmed fetal harm or very high radiation doses that unequivocally increase the risk of severe birth defects or intellectual disability. - A single accidental X-ray exposure almost certainly does not meet this threshold, as the associated risks to the fetus are minimal.

Q: A 4-year-old child while playing suddenly had his elbow pulled by his servant maid's hand and is now continuously crying, not allowing anyone to touch his elbow. He is keeping his elbow extended. What is the most likely diagnosis?

Pulled elbow. ***Pulled elbow*** - This classic presentation involves a sudden pull on the extended arm, causing the **annular ligament** to slip over the **radial head**, characteristic of a pulled elbow (Nursemaid's elbow). - The child holds the arm in a pronated-extended position, refusing to use it due to pain, and cries when the elbow is touched, which aligns with the clinical picture. *Radial head fracture* - While a fracture can occur with trauma, a history of a distinct pulling mechanism and the absence of swelling or deformity make a **pulled elbow** more likely. - A radial head fracture would typically present with more localized pain and potentially **crepitus** or obvious swelling upon examination. *Supracondylar fracture* - This fracture usually results from a fall onto an outstretched hand, a different mechanism than described. - A supracondylar fracture would typically involve significant swelling, **ecchymosis**, and potential neurovascular compromise, which are not mentioned here. *Elbow dislocation* - Elbow dislocations usually result from high-energy trauma and present with obvious deformity and severe pain. - The history of a "pull" and the child holding the arm in an **extended, pronated position** are more consistent with a pulled elbow than a full dislocation.

Q: A patient with depression was given Imipramine for 2 weeks. Relatives noticed increased excitement, colorful clothes, and increased talking. What is the next step in management?

Discontinue Imipramine and start Valproate. ***Discontinue Imipramine and start Valproate*** - The patient's symptoms (increased excitement, colorful clothes, increased talking) after starting an antidepressant like **Imipramine** suggest a **manic switch**, indicating undiagnosed **bipolar disorder**. - **Imipramine** should be discontinued as it can exacerbate mania, and a mood stabilizer like **Valproate** is necessary to treat the manic episode. *Continue Imipramine alone* - Continuing Imipramine would likely worsen the manic symptoms, leading to increased agitation and potential harm. - Antidepressants can trigger or worsen manic episodes in individuals with underlying bipolar disorder. *Manage with Valproate alone* - While Valproate is an appropriate treatment for acute mania, simply managing with Valproate alone without discontinuing the offending antidepressant would be suboptimal. - The continued presence of Imipramine would counteract the mood-stabilizing effects of Valproate. *Antipsychotic with Imipramine continued* - Adding an antipsychotic might manage some acute manic symptoms, but continuing Imipramine would maintain the driving force behind the manic switch. - The primary action should be to remove the causative agent (Imipramine) and replace it with a mood stabilizer.

Q: Which of the following is not a component of the Thoracoscore?

Expected complications post-surgery. ***Expected complications post-surgery*** - While patient risk assessment tools aim to predict surgical outcomes, the **Thoracoscore** specifically calculates risk based on present patient characteristics and surgical plan, not based on a list of expected complications. - Expected complications are a *result* of the risk score, not an input into its calculation. *ASA classifications* - The **American Society of Anesthesiologists (ASA) Physical Status Classification System** is a crucial component of the Thoracoscore, reflecting the patient's overall health status and comorbidity burden. - A higher ASA classification indicates greater surgical risk and contributes to the Thoracoscore calculation. *Surgery priorities* - **Surgery priority** (e.g., elective, urgent, emergency) is an important factor in the Thoracoscore, as urgent or emergent surgeries are associated with higher risk. - This parameter helps categorize the immediacy and complexity of the surgical intervention. *Performance status* - The patient's **performance status**, often assessed using scales like the Eastern Cooperative Oncology Group (ECOG) or Karnofsky, is a significant predictor of surgical outcome and is included in the Thoracoscore. - A lower performance status (indicating poorer functional capacity) increases the calculated surgical risk.

Question 1

Stimulation of the external auditory canal leads to cough due to which nerve?

Accepted Answer

Auricular branch of vagus

Answer

Greater auricular nerve

Answer

Auriculotemporal nerve

Answer

Facial Nerve

Question 2

Which of the following is the law on child sexual abuse in India?

Accepted Answer

Protection Of Children from Sexual Offences Act (POCSO)

Answer

Juvenile Justice (Care and Protection of Children) Act

Answer

Indian Penal Code (IPC) Section 375

Answer

Prohibition of Child Marriage Act

Question 3

Identify the condition given in the image below?

Accepted Answer

Chronic lymphedema

Answer

Cushing syndrome

Answer

Osteoporosis

Answer

None of the options

Question 4

The differentiating feature between IBS and organic GI disease is:

Accepted Answer

Presence of inflammation indicated by elevated stool calprotectin

Answer

Pain abdomen

Answer

Mucus in stools

Answer

Diarrhea

Question 5

Identify the parasite shown in the image.

Accepted Answer

Trichuris trichiura

Answer

Ancylostoma duodenale

Answer

Strongyloides stercoralis

Answer

Paragonimus westermani

Question 6

Which of the following cell components produced by Neisseria gonorrhoeae is responsible for attachment to host cells?

Accepted Answer

Pili (fimbriae)

Answer

Lipooligosaccharide

Answer

IgA1 protease

Answer

Outer membrane porin protein

Question 7

A 7 weeks pregnant lady has 1 accidental exposure to x-ray. Which of the following should be done?

Accepted Answer

Continue the pregnancy with monitoring

Answer

Perform chromosome analysis if needed

Answer

Conduct pre-invasive diagnostic testing if indicated

Answer

Consider termination of pregnancy

Question 8

A 4-year-old child while playing suddenly had his elbow pulled by his servant maid's hand and is now continuously crying, not allowing anyone to touch his elbow. He is keeping his elbow extended. What is the most likely diagnosis?

Accepted Answer

Pulled elbow

Answer

Radial head fracture

Answer

Elbow dislocation

Answer

Supracondylar fracture

Question 9

A patient with depression was given Imipramine for 2 weeks. Relatives noticed increased excitement, colorful clothes, and increased talking. What is the next step in management?

Accepted Answer

Discontinue Imipramine and start Valproate

Answer

Continue Imipramine alone

Answer

Manage with Valproate alone

Answer

Antipsychotic with Imipramine continued

Question 10

Which of the following is not a component of the Thoracoscore?

Accepted Answer

Expected complications post-surgery

Answer

Surgery priorities

Answer

ASA classifications

Answer

Performance status

NEET-PG 2020

Anatomy

Forensic Medicine

Internal Medicine

Microbiology

Obstetrics and Gynecology

Orthopaedics

Psychiatry

Surgery